碳青霉烯类耐药肺炎克雷伯菌脓毒症患者分离株CRKPⅠ类整合子和插入序列共同区分布
Chinese Journal of Nosocomiology（2023）
河南省中医院
Abstract
目的 分析碳青霉烯类耐药肺炎克雷伯菌(CRKP)脓毒症患者分离株Ⅰ类整合子、插入序列共同区(ISCR)分布情况.方法 选择2020年1月-2021年1月河南省中医院重症监护病房(ICU)收治的脓毒症患者60例,分离非重复CRKP菌株51株,采用全自动微生物鉴定仪行菌株鉴定和药敏试验,聚合酶链式反应(PCR)检测耐药基因及CRKPⅠ类整合子、ISCR分布情况.结果 51株CRKP菌株对碳青霉烯类完全耐药,对β-内酰胺类耐药率＞85％,对替加环素和多黏菌素B具有较高敏感性,耐药率分别为9.80％和7.84％;KPC-2基因阳性菌株51株,阳性率为100.00％,SHV基因阳性菌株49株(96.08％),CTX-M9基因阳性菌株36株(70.59％),NDM-1基因阳性菌株6株(11.76％),CTX-M1基因阳性菌株2株(3.92％),未检出VIM、IMP、OXA48及GES阳性菌株;检出Ⅰ类整合子阳性42株(82.35％),其中可变区阳性38株(74.51％),携带耐药基因aadA2和aadA5,检出ISCR阳性5株(9.80％),其中可变区1株,携带耐药基因sul1,检出同时携带Ⅰ类整合子和ISCR菌株3株.结论 脓毒症患者分离的51株CRKP菌株均携带KPC-2基因,同时携带其他耐药基因,CRKP菌株中Ⅰ类整合子分布广泛,ISCR分布较少,二者以串联形式存在并可能造成耐药基因在不同CRKP克隆株之间水平传播,从而导致CRKP菌株耐药的复杂性以及多样性.
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Key words
Sepsis,Carbapenem-resistant Klebsiella pneumoniae,Integron,Insertion sequence common region,Drug resistance gene,Distribution,Epidemiology
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